Disk excision using end-to-end anastomosis circular stapler for deep endometriosis of the rectum: a 492-patient continuous prospective series

Elsevier

Available online 2 November 2022

Journal of Minimally Invasive GynecologyAbstractStudy Objective

To report a large series including women managed by disk excision using end-to-end anastomosis (EEA) circular transanal stapler to assess the feasibility of the technique, the features of nodules suitable for removal by disk excision and the rate of major early complications.

Design

Retrospective study on data prospectively recorded in two databases.

Setting

Two tertiary referral centers.

Patients

492 patients undergoing surgery for rectal endometriosis from May 2011 to June 2022.

Interventions

Rectal disk excision using the EEA stapler.

Measurement and main results

Disk excision using EEA was performed in 492 patients (24.2%) out of 2,029 women receiving surgery for deep endometriosis infiltrating the rectum during the 11-year study period. Deep endometriosis involved low rectum in 11% and mid rectum in 55.3%. The diameter of rectal nodules exceeded 3 cm in 65.9%. Mean operative time was 2 hours, mean diameter of rectal patches removed was 41+/-11 mm, and the mean rectal suture height was 9.2+/-5.5 cm. The presence of microscopic foci on the edges of rectal patches was identified in 30.2% of cases. Rectal fistula was recorded in 20 patients (4%). The distance from the anal verge was significantly lower in patients with fistula when compared to women with no fistula (5.9+/-2 cm vs. 9.2+/-5.6 cm, P=0.027). Follow up ranged from 1 to 120 months, with a median value of 36 months. MRI in 3 patients during follow-up revealed a recurrent nodule infiltrating the previous stapled line (0.6%) after a postoperative delay of respectively 36, 48 and 84 months.

Conclusions

Disk excision using the EEA stapler is suitable in nodules over 3 cm if surgeons ensure deep shaving of the rectum, to allow complete inclusion of the shaved area into the stapler jaws. Postoperative rectal recurrences appear incidental, while bowel leakage rate is comparable to that following colorectal resection. This technique is suitable in almost a quarter of patients managed for rectal endometriosis nodules and is therefore a valuable technique that warrants more widespread use.

Keywords

deep endometriosis

rectum

disk excision

rectovaginal fistula

EEA stapler

© 2022 Published by Elsevier Inc. on behalf of AAGL.

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